Basic Information
| Provider Information | |||||||||
| NPI: | 1841663903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOWLES | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784864037 | ||||||||
| Practice Location | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784864037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2015 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 2328831 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.